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On Health Care, It's Hurry Up and Wait

This story was written by political reporter Stephanie Condon.

Amid a days-long media blitz in which President Obama urged Congress to pass health care legislation this summer, a reporter queried the president at a televised, prime time news conference Wednesday night, asking, "Why the rush?"

"I'm rushed because I get letters every day from families that are being clobbered by health care costs. And they ask me, can you help?" Mr. Obama answered.

"So I've got a middle-aged couple that will write me and they say, 'Our daughter just found out she's got leukemia, and if I don't do something soon we just either are going to go bankrupt, or we're not going to be able to provide our daughter with the care that she needs.' And in a country like ours, that's not right. So that's part of my rush."

Indeed, the White House has worked hard to create a sense of urgency over health care legislation. But for many of the reforms being touted, Americans are being told to hurry up - and then wait. Significant provisions of the health care legislation under consideration, it turns out, will not go into effect until 2013.

Mr. Obama addressed this fact at an Ohio town hall on Thursday.

"Most of these changes would be phased in over several years," he said. "So it's not as if you're going to wake up tomorrow and suddenly the health care system is all changed completely. We are going to phase this in, in an intelligent, deliberate way."

While momentous changes certainly take time to implement, this means by 2010 -- and even 2012 -- Democrats may not be able to boast of reducing the number of uninsured. In fact, they may have to explain an increased number of uninsured, according to government estimates.

There would be reforms in place within a year of the bill's passage that could make serious changes in people's lives, such as prohibiting insurance companies from denying coverage to those with pre-existing conditions. But at the time of Mr. Obama's next election campaign, people will still be waiting for subsidies to help with crippling health care costs as well as the "public option" that the president says will keep private insurers in check.

Many have argued that the Mr. Obama's political capital rests on the passage of health care legislation. Yet with many of the most significant pieces of reform left on the drawing board for four more years even if the legislation is passed, the issue of health care reform could still prove to be problematic for Democrats in 2010 and 2012.

When Would Americans See Changes?

Most of the proposed changes intended to reduce the number of uninsured Americans and relieve some of the costs of health care are slated in the House legislation to take effect in 2013. These include the government-sponsored health insurance plan, or "public option," and the health insurance exchange -- the marketplace where individuals and small businesses will be able to find cheaper insurance plans.

The provisions slated to take effect in 2013 also include an expansion of Medicaid eligibility to those whose income is at or below 133 percent of the poverty line (or $29,300 for a family of four), and subsidies for those who fall between 133 percent and 400 percent of the poverty line. The mandate in the bill for all individuals to acquire health insurance and the mandate for all employers to either provide insurance or pay a price also takes effect in 2013.

A preliminary analysis (PDF) of the House bill from the Congressional Budget Office estimates that after the bill's enactment, the number of uninsured Americans would actually increase by two million to a total of 52 million by 2012. After the major reforms were implemented, that figure would drop to 27 million in 2013 and eventually to 17 million in 2017, the CBO estimates.

That four-year delay for implementation would likely not sit well with grassroots progressives who share the sense of urgency Mr. Obama has conveyed and have worked hard to support Democrats' reform efforts. The grassroots group, which has five million members, considers health care reform its top issue.

"MoveOn members see this as an urgent crisis, and want it solved as fast as possible," said MoveOn's executive director Justin Ruben. "Health care costs are spiraling out of control, and the public plan is a critical piece of bringing costs down and making care affordable, and so are the subsidies. The bottom line is, the sooner health care reform begins making a difference in people's lives, the better... and the better it will be for politicians sticking their reputation on solving it."

While those sweeping changes would be implemented in 2013, others would go into effect more quickly. For instance, thanks to an amendment from Rep. Joe Courtney (D-Conn.), market reforms to prohibit insurance companies from denying coverage to those with pre-existing conditions will go into effect six months after the bill is passed -- rather than in 2013, as originally proposed.

"Will it make a difference for Americans not to be denied coverage because of pre-existing conditions? Absolutely," Ruben said.

Furthermore, within the first year of its enactment, the House legislation would prohibit rescissions, the abusive practice of health insurance companies rescinding existing health insurance policies as a way of avoiding costs. It would also boost Medicaid reimbursements for primary care and improve preventive health coverage in Medicare and Medicaid. On top of that, it would in 2010 increase funding for community health centers and expand training programs for primary care physicians and nurses.

In an interview, Courtney said the rollout of the major benefits is simply limited by what can practically happen in a given time frame.

"If I had my druthers, we would have it up and running as quickly as we could," he said. "There really is an honest-to-God logical challenge to setting up a new program that quickly. Once you get through this legislative sausage process, it's not going to kick in the next day."

He said the president and other Democrats will have to "deal with it head on" and explain why the changes take time.

"You try to visualize what (people) are going to be living through for three or four years... I'm sure people will be upset," Courtney said.

Courtney called the 2013 target an "outside date" and said the intent of the House Education and Labor Committee was to leave room for the Secretary of Health and Human Services -- who would be responsible for administering some of the major reforms -- to accelerate the process.

"I would imagine there would be political pressure to try and beat that date," he said.

A Potential GOP Talking Point

While Mr. Obama and congressional leaders may have to placate liberals on the delayed timeline, Republicans could easily use it against the Democrats, conservatives say, in the same way the GOP has railed against the incremental roll out of the $787 billion stimulus package.

"I'd like to ask my folks back in Ohio, where the unemployment rate is at 11.2 percent, whether they've been rescued by (the Democrats') economy," Rep. John Boehner said at a health care press conference Wednesday. "And if they try to fix our health care system like they've tried to rescue our economy, I think we're in really, really big trouble."

Bradley Blakeman, a Republican strategist who served in the Bush administration, said Mr. Obama has done himself a disservice by adopting the same kind of urgent tone in his health care rhetoric that he had when pushing the American Recovery and Reinvestment Act.

"Everything seems to be an emergency," Blakeman said. "He got his stimulus, 80 percent of which is unspent. He promised jobs would increase, and the money would be flying out the door. We know that none of that is coming to fruition, and yet the president put his prestige on the line. He's lost his credibility on emergency legislation."

But Ruben from MoveOn said it would be "the height of irony" for Republicans to criticize Democrats for the slow implementation of health reforms, after "using every tactic they can think of to delay" the process.
"I think MoveOn members and most Americans... understand problems can't be solved over night," he said. "The question they're going to be asking is, 'Is our government working hard to fix them?'"

Blakeman suggested that given the weak economy and high cost of reform, Republicans will be able to argue that the changes will bring about more harm than good. That point will be underscored, he said, if the Congress enacts an income surtax to pay for reforms in 2011, two years before the government plan takes effect, as the House has suggested.

"It's all about the economy, and that's what the president and the Democrats are missing," he said. "I think the American people are going to say, 'What did we buy here?'"

By Stephanie Condon

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